Distinct neuropsychological subgroups in typically developing youth inform heterogeneity in children with ADHD
Distinct neuropsychological subgroups in typically developing youth inform heterogeneity in children with ADHD
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DOI：
10.1073/pnas.1115365109
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发表时间：
2012-04-24
影响因子：
11.1
通讯作者：
Nigg, Joel T.
中科院分区：
文献类型：
--
作者：
Fair, Damien A.;Bathula, Deepti;Nigg, Joel T.
精神病学的研究和临床调查在很大程度上依赖于这样一个事实上的假设：《精神疾病诊断与统计手册》（DSM）中确定的诊断类别代表了同质的综合征。然而，现有分类方案潜在的机制异质性可能会限制大多数发育性精神疾病病因的发现。另一个也许不太明显的现实可能也在干扰进展——正常发育人群中的异质性。在本报告中，我们试图利用图论和社区检测方法，在一个包含大量正常发育青少年和注意缺陷/多动障碍（ADHD）青少年的大型数据集中阐明神经心理学的异质性。我们试图确定在患有和未患有该疾病的儿童中是否可以辨别出数据驱动的神经心理学亚型。由于个体分类是最终临床转化的必要条件，我们还应用基于支持向量机的多元模式分析来确定根据社区检测所描绘的亚型定义，个体儿童的ADHD状态能被识别的准确程度。分析在两个人群中都产生了几个独特但相似的亚型。同样重要的是，在这些不同的亚组中分别比较正常发育儿童和ADHD儿童提高了诊断准确性。我们确定了两个重要原则，它们有可能增进我们对正常发育和发育性神经精神疾病的理解。第一个原则表明，正常发育儿童可以高精度地被分类为不同的神经心理学亚组。第二个原则提出，ADHD个体中的一些异质性可能“嵌套”在这种正常变异中。
Research and clinical investigations in psychiatry largely rely on the de facto assumption that the diagnostic categories identified in the Diagnostic and Statistical Manual (DSM) represent homogeneous syndromes. However, the mechanistic heterogeneity that potentially underlies the existing classification scheme might limit discovery of etiology for most developmental psychiatric disorders. Another, perhaps less palpable, reality may also be interfering with progress-heterogeneity in typically developing populations. In this report we attempt to clarify neuropsychological heterogeneity in a large dataset of typically developing youth and youth with attention deficit/hyperactivity disorder (ADHD), using graph theory and community detection. We sought to determine whether data-driven neuropsychological subtypes could be discerned in children with and without the disorder. Because individual classification is the sine qua non for eventual clinical translation, we also apply support vector machine-based multivariate pattern analysis to identify how well ADHD status in individual children can be identified as defined by the community detection delineated subtypes. The analysis yielded several unique, but similar subtypes across both populations. Just as importantly, comparing typically developing children with ADHD children within each of these distinct subgroups increased diagnostic accuracy. Two important principles were identified that have the potential to advance our understanding of typical development and developmental neuropsychiatric disorders. The first tenet suggests that typically developing children can be classified into distinct neuropsychological subgroups with high precision. The second tenet proposes that some of the heterogeneity in individuals with ADHD might be "nested" in this normal variation.